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Individual

MARA BETH COYNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1505 WILSON TER, SUITE 200, GLENDALE, CA 91206-4071
(818) 246-8974
(818) 246-7673
Mailing address
27426 CHERRY CREEK DR, VALENCIA, CA 91354-2056
(661) 297-3930

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PT-18312
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT-18312
PHYSICIAN ASSISTANT
CA
Enumeration date
05/26/2006
Last updated
12/02/2021
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